The state is crafting new rules to protect health care patients from surprise medical bills and is starting to gather feedback on what those protections should look like.
Both a new federal law and state law will go into effect in January 2022 that are both aimed at protecting patients who get stuck with bills after accidentally going out-of-network. Patients will be protected from being stuck with the balance of the bill under two new laws.
In Ohio, on average 18% of emergency visits result in at least one out-of-network charge, Kaiser Family Foundation notes in a February analysis of surprise billing.
While the Ohio law was passed in January, it won’t be implemented until January 2022 and this year, Ohio Department of Insurance will be talking with the general public and people in the health care industry to hammer out how the new protections will work.
Regulators are also sorting out how the federal and state laws interact, because while the laws are similar, they aren’t exactly the same. For example, the state law includes ambulance patients, the federal law does not. Also, the new Ohio law is for fully-insured health plans, while the federal law covers fully insured and self-insured patients.
The changes are a response to a practice often called surprise billing, which typically happens when an insured patient thinks they are in-network, such as a patient at an in-network hospital but then is treated by a contractor who is not in the patient’s insurance network. At a hospital, the anesthesiology practice, on-call specialists, the pathology lab and more can all be separate small businesses that each may or may not also have a contract with the patient’s insurance.
Judith French, Ohio Department of Insurance director, said in a newsletter that the recently signed House Bill 388 protects Ohioans from receiving surprise medical bills for emergency care, or, in certain circumstances, unexpected out-of-network care.
“It prohibits balance billing in these instances, leaving price negotiation between the health provider and health insurance plan with the department’s oversight,” French said.
The new law takes the consumer out of these disputes and requires the providers and insurers to resolve payment disputes through arbitration — a process we are working to implement now.
French encouraged industry stakeholders to the surprise billing toolkit on insurance.ohio.gov to review information identified as needing addressed during the rule-making process, and to send in their comments.
“We are excited to engage the public on such an important topic and to positively impact the lives of Ohio insurance consumers. We look forward to your participation,” French said.
The department will have a draft available for public comment later this spring and at that time, anyone will be welcome to provide feedback. Once those comments are reviewed and necessary changes are made to the draft, there will be additional opportunities for comment as part of Ohio’s Common Sense Initiative review process.
People with questions or concerns can also contact the department at 800-686-1578 or insurance.ohio.gov.
The department started the feedback process in March. Since the feedback process just started, many providers and lobbying groups are still reviewing the text and gathering their own feedback before giving their input.
Kelly O’Reilly, president and CEO of the Ohio Association of Health Plans, which represents health insurers, said the association is “pleased that ODI is engaging in such a robust dialog with all of the stakeholders” but is still gathering input from members about how they want to see the rules shape up.
Dr. Bryan Graham, with the Ohio chapter of the American College of Emergency Physicians, said the association will be closely watching to see how the Ohio and federal laws work together.
“Our stance, all along, is just keep the patients out of the middle and make sure that whatever we do is going to be a fair and efficient process for the providers who are delivering the care,” Graham said.
The Story So Far
Previously: For more than two years, federal lawmakers and lobbyists have debated different surprise billing legislation and similar bills have been debated for years in the Ohio legislature as well. Two laws, one federal and one state, passed around the beginning of the year.